Feedback Form We would like you to think about your most recent experience with the Muscular Dystrophy Association Question Title * 1. What part of our service did you interact with? Please click on the arrow and select the best option from the list. Information Service Fieldworker Service Accounts & Fundraising Branch Office Manager Branch - Other National Office - Other Question Title * 2. How did you feel following your experience with the MDA? (Select as many options as you like) Positive Valued Responded to Connected Supported Informed None of the above (please specify) Question Title * 3. How likely are you to recommend our service to Friends, Whānau, Colleagues or Patients if they needed similar support or information? Extremely unlikely Unlikely Neither likely or unlikely Likely Extremely likely Extremely unlikely Unlikely Neither likely or unlikely Likely Extremely likely Question Title * 4. Please can you tell us the main reason for the score you have given? Question Title * 5. I am a... MDA Member Health Professional Whānau Supporter Donor Community Member Other (please specify) Question Title * 6. Please select from the list below to show the region you are based in (or the nearest one) Northland Auckland Waikato South Waikato, Bay of Plenty Rotorua, Taupo Gisborne, Napier Taranaki, Whanganui Mid Central Wellington Nelson, Blenheim West Coast Kaikoura, North Canterbury Christchurch, South Canterbury Otago Southland Question Title * 7. Is there anything else you would like to tell us? Done
